JMIR Publications

ABSTRACT

Background:

Clinical practice over the years at home and abroad has demonstrated that early warning, timely diagnosis, prompt intervention, and immediate treatment are effective strategies in preventing the development of LVD. The early identification of high-risk individuals and the proactive prevention of LVD have gained growing attention and emphasis. However, its risk factors are complex and diverse, thus actively exploring these factors in LVD and constructing personalized warning models using relevant clinical variables hold significant importance in assessing the disease risk for patients. Yet, to date, there has been insufficient research by scholars, both domestically and internationally, on the risk factors and warning models for LVD. In light of these gaps, this study represents the first systematic exploration of the risk factors associated with LVD. Employing an evidence-based medicine approach, a warning model has been constructed, offering a tool for the early identification of high-risk individuals. Furthermore, this model has the potential to enhance the diagnostic and treatment capabilities of medical personnel in primary community health service centers. This holds great significance in mitigating overall healthcare expenditures and the disease burden.

Objective:

The risk factors of lichenoid vulvar disease (LVD) in women were explored and a medically evidence-based warning model was constructed to provide an early alert tool for the high-risk target population. The model can be applied in the clinic to identify high-risk patients and evaluate its accuracy and practicality in predicting LVD in women. Simultaneously, it can also enhance the diagnostic and treatment proficiency of medical personnel in primary community health service centers, which is of great significance in reducing overall healthcare spending and disease burden.

Methods:

2990 patients who attended West China Second Hospital of Sichuan University from January 2013 to December 2017 were selected as the study subjects, and were divided into 1218 cases in the normal vulvovagina group (group 0) and 1772 cases in the lichenoid vulvar disease group (group 1) according to the results of the case examination. We investigated and collected routine examination data from patients for intergroup comparisons, included factors with significant differences in multifactorial analysis, and constructed logistic regression (LR), random forests (RF), gradient boosting machine (GBM), and adaboost (ADA) analysis models. The predictive efficacy of these four models was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC).

Results:

Univariate analysis revealed that vaginitis, urinary incontinence, humidity of the long-term residential environment, spicy dietary habits, regular intake of coffee or caffeinated beverages, daily sleep duration, diabetes mellitus, smoking history, presence of autoimmune diseases, menopausal status, and hypertension were all significant risk factors affecting female LVD (P < 0.05). Furthermore, the area under the ROC curve, accuracy, sensitivity, and F1-score of the GBM warning model were notably higher than the other three predictive analysis models. The GBM analysis model indicated that menopausal status had the strongest impact on female LVD, showing a positive correlation, followed by the presence of autoimmune diseases, which also displayed a positive dependency.

Conclusions:

In accordance with evidence-based medicine, the construction of a predictive warning model for female LVD can be employed to identify high-risk populations at an early stage, aiding in the formulation of effective preventive measures, which is of paramount importance for reducing the incidence of LVD in women.